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Tommaso Claudio Mineo, MD; Vincenzo Ambrogi, MD; Marcello Paci, MD; Nicola Iavicoli, MD; Eugenio Pompeo, MD; Italo Nofroni, BS

Arch Surg. 2001;136:783-788.

Objective  To evaluate indications, limits, and merits of transxiphoid bilateral palpation during video-assisted thoracoscopy (VAT) lung metastasectomy.

Design  Survey retrospective study with a minimum follow-up of 1 year.

Setting  University hospital.

Patients  From December 1995 to September 1999, 29 of 45 patients operated on for pulmonary metastasectomy were approached through a transxiphoid VAT. Primary sites were colon-rectum (n = 13), kidney (n = 4), limb osteosarcoma (n = 3), uterus (n = 2), larynx (n = 2), breast (n = 1), skin melanoma (n = 1), prostate gland (n = 1), back fibrosarcoma (n = 1), and ovary (n = 1). Bilateral palpation was performed in 23 patients, although only 10 had radiological evidence of bilateral disease.

Results  No perioperative or 30-days postoperative mortality was recorded. Acute and chronic pain was similar to that of other VATs and significantly less than sternotomy. Mean ± SD chest-drain time and hospital stay were 2.8 ± 1.19 days and 4.3 ± 1.78 days, respectively. Sixty-nine lesions, 60 of them metastatic, were resected by laser (n = 29) or stapler (n = 40). Bilateral exploration permitted the discovery of 15 radiologically undetected lesions, 11 of which were found to be malignant. Contralateral metastases were found in 5 patients predicted to have unilateral disease. Mean ± SD follow-up was 22.89 ± 10.87 months (range, 9-60 months). Six patients developed new pulmonary metastases after a mean interval of 13.6 months; 3 of these patients relapsed in the unexplored hemithorax after 6, 9, and 12 months, respectively.

Conclusions  The use of the transxiphoid VAT approach was safe, applicable in many instances, and effective in detecting occult metastases by manual bilateral palpation. The advantages of a VAT procedure can be coupled with those provided by a radical operation.

From the Department of Thoracic Surgery, Tor Vergata University, Rome, Italy (Drs Mineo, Ambrogi, and Pompeo); the Department of General Surgery, Calai Hospital, Gualdo Tadino, Italy (Dr Paci); the Department of General Surgery, Civil Hospital, Agnone, Italy (Dr Iavicoli); and the Department of Biostatistics, La Sapienza University, Rome (Mr Nofroni).

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